Discharged on supplemental oxygen from an emergency department in patients with bronchiolitis

Bronchiolitis is the most common reason for hospital admission in patients aged <1 year. Admissions have been increasing with hypoxia frequently cited as the determinant. Home oxygen (O(2)) has been shown to be feasible, although safety data are lacking. The objective of this study was to evaluate the impact of a home O(2) clinical care protocol on admission rates in patients with bronchiolitis from the pediatric emergency department.

We performed a retrospective chart review of patients with bronchiolitis who presented to a children's hospital pediatric emergency department (altitude 1600 m) between 2005 and 2009. Patients between the ages of 1 and 18 months were included in the analysis. Patients requiring baseline O(2) were excluded. We calculated the percentage of patients discharged on O(2) and their readmission rates. We reviewed charts of patients who were admitted after home O(2) for adverse outcomes. We also compared rates of admission before and after initiation of the protocol.

In this study, 4194 illnesses were analyzed; 2383 (57%) were discharged on room air, 649 (15%) were discharged on O(2), and 1162 (28%) were admitted. Of those discharged on room air, 4% were subsequently admitted, and 6% of those discharged on O(2) were admitted. There were no ICU admissions or need for advanced airway management in those patients discharged on O(2). Our overall admission rates for bronchiolitis dropped from a rate of 40% to 31%.

Home O(2) is an effective way to decrease hospital admissions in a select group of patients with bronchiolitis.